Quality assurance/control issues. International Academy of Cytology Task Force summary. Diagnostic Cytology Towards the 21st Century: An International Expert Conference and Tutorial.
OBJECTIVE
General definitions of quality assurance and quality control (QA/C) have existed in many forms for decades, and a new discipline guides their application to diverse industrial and recently medical processes without much fanfare. However, in the field of cervical cytology screening, the range of QA/C options has recently broadened and become controversial. With the advent of new systems of terminology, larger-scale laboratories and new technologies--plus strong governmental and legal pressures in some nations--the range of extremely difficult and sometimes expensive QA/C choices our community faces is greater than ever.


METHODS
At our conference, the basic definitions of QA/C posed little difficulty. Presentation of the range of methods in use today and of those based on new technologies where use is proposed or has just begun also was achieved with little or no dispute. However, there was lack of consensus on exactly how QA/C methods are to be assessed. Indeed, there was little consistency in the use of different outcome measures with which we can judge success or failure of specific QA/C options. In addition, the tension between pressure to adopt sometimes uncertain or expensive method enhancements and pressure to maintain affordability and the widest possible access for populations that most need cervical cytology screening is greater than ever.


CONCLUSIONS
More data are required that would enable assessment of QA/C options with the clearest possible understanding of cost/benefits and current or new assumptions of risk. Other task forces, such as medicolegal, cost/benefit and those devoted to new technologies, are our essential partners in meeting the challenges described above.
Krieger
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Quest Diagnostics Incorporated, Teterboro, New Jersey 07608-1070, USA.
McGoogan
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D014487:Centers for Medicare and Medicaid Services, U.S.; D003584:Cytological Techniques / Q000592:standards*; D004059:Diffusion of Innovation; D005260:Female; D006801:Humans; D017063:Outcome Assessment, Health Care; D011634:Public Health; D011785:Quality Assurance, Health Care / Q000379:methods; D011786:Quality Control; D014481:United States; D002577:Uterine Cervical Diseases / Q000473:pathology; D002583:Uterine Cervical Neoplasms / Q000473:pathology / Q000517:prevention & control; D014626:Vaginal Smears / Q000592:standards